MIMC Membership
Application
Name__________________________________
Title____________________________________
Company_______________________________________________________________________
Address________________________________________________________________________
City______________________________ State____________
Zip________________________
Phone
#____________________________
Fax
#_____________________________________
Email________________________________
URL______________________________________
Brief Description of
Company or Firm:
________________________________________________
How did you hear
about MIMC?
______________________________________________________
Types of Membership
Affiliate: Non-technology
professional service firms that provide services to the interactive media
industry (legal, financial, accounting, consulting, HR, PR, staffing, and
recruiting),
___ $3,000/yr
Corporate: Companies who provide, design, build, and
deliver interactive technology products and services.
# of employees
Cost
___ 1-20 $250/yr
___ 21-50
$500/yr
___ 51-100
$750/yr
___ 101-500
$1,500/yr
___ 501+
$3,000/yr
Corporate Sponsor:
Premium level of
membership to any company that wants to be a headlining supporter of MIMC.
___ $5,000/yr
Individual:
Available to
freelancers, independent contractors, and individuals within companies that
fall under the corporate member definition.
___ $100/yr
Student:
Must be enrolled full
time in college or university.
___ $25/yr
Payment can be made
by credit card or check made payable to MIMC.
(Mailing address below)
Visa/MC/Amex
#______________________________________
Exp. Date_______________
Signature
____________________________________________________________________
